Clinical Practice Guideline: Colorectal Cancer—Diagnosis, Treatment, Prevention, and Long-Term Follow-Up Care.

backgroundApproximately 24 000 people die of colorectal cancer (CRC) in Germany each year. New developments in prevention, diagnosis, and treatment are improving long-term outcomes. These measures have been incorporated in the updated guideline and are presented here along with the findings of other new randomized controlled trials (RCTs).

methodsA systematic search (2022–2023) was conducted for guidelines, reviews/meta-analyses, and primary studies (search term “colorectal cancer”; databases: international guideline registries, PubMed, Cochrane). 123 reviews were identified, evaluated, and used in the creation of the guideline.

resultsEarly detection is performed with colonoscopy every 10 years, sigmoidoscopy every 5 years, or an immunological stool test for occult blood every 1–2 years; it can lower cancer-related mortality by up to 30%. Hereditary forms (Lynch syndrome, polyposis) require more intensive monitoring. All diagnosed cases must be presented to a tumor board. In the case of low-risk pT1 carcinoma, extended resection is not indicated after complete endoscopic removal. In a recent RCT, the recurrence rate was lower after robotic surgery than after laparoscopy (3-year recurrence rate 1.6% and 4.0% respectively; adjusted hazard ratio, 0.39; 95% confidence interval: [0.19; 0.80]). Treatment of patients with mismatch repair deficiency (dMMR) or microsatellite instability-high (MSI-H) cancers with checkpoint inhibitors yields response above 90%. Further systemic therapies are based on the molecular tumor profile (dMMR/MSI-H, RAS, and BRAF). Organ sparing management may be an option for rectal cancer patients in complete remission after neoadjuvant therapy; however, this requires close follow-up monitoring.

conclusionThe efficacy of early detection is undisputed. Less evidence is available concerning the optimal level of intensity of follow-up care. The clinical and molecular stratification of tumors enables differential treatment. Organ-preserving strategies after a complete response to therapy are an important area of current research.